The purpose of this study is to evaluate a caregiver skill training program (HI-FIVES), offered as a part of a randomized control trial to caregivers of Veterans referred to home and community-based long-term care. Of primary interest is to examine whether participating in HI-FIVES leads to clinically significant increases in days spent at home for Veterans compared to caregivers in usual care. The investigators aim, through the training, to decrease the number of days over 12 months post-intervention that Veterans spend in the emergency department, hospital, or nursing home. Days spent in these settings reduces the Veteran's quality of life and increases health care costs to the VA. The investigators also will evaluate whether caregivers in HI-FIVES have clinically significant reductions in depressive symptoms post-intervention compared to caregivers in usual care.

Patient days in the community (e.g. days not in emergency department, inpatient, or nursing home setting) [ Time Frame: 12 months ] [ Designated as safety issue: No ]

Days at home up to12 months post-treatment is simply 365 minus the total number of days of VA or non-VA ED, inpatient, and nursing home care, whereas days not at home is the count of days in ED, inpatient or nursing home care.

Secondary Outcome Measures:

Total costs to the VA [ Time Frame: 12 months ] [ Designated as safety issue: No ]

VA utilization costs will be summarized across VA and non-VA contracted care and will capture all outpatient costs (laboratory, radiology, pharmacy, surgery, nursing, and treat and release ED visits) and inpatient costs (similar categories). Intervention costs will include labor and capital costs.

CAHPS. Used by the VA Office of Performance and Quality, this outcome is considered a key measure of patient satisfaction with inpatient and outpatient care. The investigators will focus on a global satisfaction measure about the health plan: Using any number from 0 to 10, where 0 is the worst health care possible and 10 is the best health care possible, what number would the patient use to rate all of his/her health care in the VA in the last 3 months?

Caregivers in the control arm will be referred to the VA Caregiver Support Program (usual care), as a resource for them as they care for the patient in the home. The patient of each caregiver will also be enrolled and contact will be limited to assessments.

Usual care will be the Veteran patient care and caregiver support that are normally offered once the Geriatrics and Extended Care (GEC) referral process has occurred. This process entails the patient and caregiver work with the social worker assigned to the patient to obtain home and community based care (HCBC) services. The patients in the usual care group will be free to seek medical, psychological, social support, and social services that are available through VAMCs or any other source. In addition to this, caregivers in the usual care arm will be told about the caregiver support programs in the VHA and the caregiver will receive the national VA caregiver hotline phone number (see Appendix VI for this pamphlet). The information provided mirrors efforts to support caregivers in the VA nationally and new standards of care for VA caregivers. This will be the only contact with the usual care subjects besides the scheduled data collection assessments.

Other Name: Control

Experimental: Arm 2

Caregivers will take part in three phone training sessions and will attend four group training sessions at the VA. They will also be given the option of participating in 2 booster phone training sessions post-group sessions. Caregivers will be asked to provide one in-person (baseline) and three phone assessments (3, 9, and 15 months). Patients will also be enrolled and contact will be limited to assessments

Caregivers in the HI-FIVES group will receive individual calls with a nurse educator to address topics he/she identified as being the highest priority learning areas. After the phone calls, caregivers will participate in evidence-based group sessions aimed to improve clinical care skills, psychological care skills, and support-seeking skills. The curriculum will be delivered by a trained nurse educator on the research team and the PI and VA Caregiver Support Staff. Three individual telephone training calls will be tailored to the individual needs of Veteran-caregiver dyad. Four group training sessions will be targeted to address common needs of Veterans and their caregivers. Given that all Veteran care recipients will have at least 2 or 3 ADL limitations. After the final group session, there will be two optional booster calls at one and three months. Four assessments in all will be collected, baseline (in person), and at 3, 9, and 15 months (by phone).

Patient referred to home and community-based services in the past 3 months,

not eligible for hospice,

residing at home,

has an informal caregiver, and willing to let us contact the caregiver.

To be referred successfully to HCBC,

patients will have a minimum of 2 activity of daily living limitations,

and are likely to have multimorbidity, including high rates of cognitive impairment.

Exclusion Criteria:

Cognitively impaired Caregiver

Caregiver does not have access to a telephone.

Severely impaired hearing or speech (Caregivers must be able to respond to phone calls).

English Language Impaired - Caregiver

Substance Abuse Disorders - Caregiver

Caregiver participating in other caregiver intervention

Patient referred only for physical or occupational therapy

Patient or caregiver refuses informed consent

Patient in hospital

Contacts and Locations

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study.
To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below.
For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01777490